Measuring Atopic Eczema Control and Itch Intensity in Clinical Practice
Authors: Yael A. Leshem, Joanne R. Chalmers, Christian Apfelbacher, Norito Katoh, Louise A. A. Gerbens, Jochen Schmitt, Phyllis I. Spuls, Kim S. Thomas, Laura Howells, Hywel C. Williams, Eric L. Simpson, Katrina Abuabara, Jiyoung Ahn, Valeria Aoki, Christian Apfelbacher, Takahiro Arai, Bernd Arents, Maren Awici-Rasmussen, Arabella Baker, Bo Bang, Lauren Baughman, Lisa Beck, Angela Bosma, Tim Burton, Vanessa Byrnes, Brian Calimlim, Korey Capozza, Jo Chalmers, Rajeev Chavda, Amy DeLozier, Aaron Drucker, Toshiya Ebata, Laurence Eichenfield, Carsten Flohr, Surina Frey, Masaki Futamura, Michaela Gabes, Susannah George, Louise Gerbens, Erin Grinich, Kristin Grossouw, Laura Howells, Alan Irvine, Yoko Kataoka, Norito Katoh, Urs Kerkmann, Sandra Lawton, Dong Hun Lee, Yael Leshem, Astrid H. Lossius, Tomoko Maeda-Chubachi, David Margolis, Takeshi Matsui, Stephanie Merhand, Mami Murakami, Hiroyuki Murota, Takeshi Nakahara, Fabio Nunes, Yukihiro Ohya, Peck Ong, Raquel Leão Orfali, Amy Paller, Magali Redding, Catalina Rincón Pérez, Amanda Roberts, Natasha Rogers, Jochen Schmitt, Neil Shear, Jonathan Silverberg, Eric Simpson, Jasvidner Singh, Wendy Smith Begolka, Phyllis Spuls, Jean-Francois Stalder, Philip Sugerman, Ake Svensson, Kim Thomas, Jacob Thyssen, Gail Todd, Floor van der Most, Karlijn van Halewijn, Helle Vestby, Christian Vestergaard, Annika Volke, Laura von Kobyletzki, Carl-Fredrik Wahlgren, Elke Weisshaar, Hywel Williams, Andreas Wollenberg, Yang Zhao
Journal: JAMA Dermatology (2022)

Measuring outcomes in clinical practice can aid patient care, quality improvement, and real-world evidence generation. The Harmonising Outcome Measures for Eczema (HOME) Clinical Practice initiative is developing a list of validated, feasible instruments to measure atopic eczema in clinical care. Prior work identified symptoms and long-term control as the most important domains to measure in clinical practice. The Patient-Oriented Eczema Measure (POEM) and the Patient-Oriented Scoring Atopic Dermatitis Index (PO-SCORAD) were recommended by consensus to measure symptoms in clinical practice, but a need for instruments to measure itch intensity specifically was recognized. The HOME group also previously decided that long-term control should be captured by repeated measurements of eczema control. Recommended instruments to measure eczema control in clinical practice have not been defined.To recommend instruments to measure eczema control and itch intensity in patients with atopic eczema in clinical practice.Available instruments to measure eczema control and itch intensity were identified through systematic reviews, informing a consensus process held at the HOME VIII virtual online meeting (October 6 and October 9, 2020). Feasibility aspects were highlighted to optimize instrument selection for the clinical practice. Consensus on an instrument was reached if fewer than 30% of the voters disagreed.Of 7 identified instruments, the Recap of Atopic Eczema (RECAP) and Atopic Dermatitis Control Tool (ADCT) were the recommended instruments to measure eczema control (3 of 63 [5%] and 7 of 69 [10%] of voters disagreed, respectively). A single-question patient global assessment garnered support, but the current available instrument did not reach consensus. Six available itch-intensity instruments were identified. Of them, 3 instruments were recommended by consensus: a peak 24-hour numeric rating scale (NRS)-itch, and 1-week NRS-itch instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire, measuring average and peak itch (11 of 63 [17%], 14 of 63 [22%], and 16 of 59 [27%] voters disagreed, respectively).Clinicians and patients are encouraged to incorporate these well-validated, quick-to-perform, and easy-to-use instruments into their clinic, selecting the instruments that best fit their need. These assessments are meant to enhance, not replace, the patient-clinician encounter, and to support real-world research and health care improvement.